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Damage Control Orthopaedics

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Armed Conflict Injuries to the Extremities

Abstract

University of Maryland School of Medicine

Julie M. Keller MD, Andrew N. Pollak MD

In damage control for trauma patients, the main tenets are to perform temporary operative procedures to provide time for physiologic stabilization before definitive surgical care. There are four distinct phases of the damage control philosophy: the first is recognition of the at risk patient; next, temporizing operative procedures to limit ongoing injury; third, intensive care unit (ICU) care for resuscitation; and finally, definitive procedures in the OR.

Hemorrhage is the leading cause of preventable death after trauma, and strategies for preserving vital function while preventing further blood loss allow for stabilization and safe transport. In the hospital phase, damage control resuscitation is focused on preventing or correcting the lethal triad of hypothermia, acidosis and coagulopathy. Orthopaedic care of patients in extremis has undergone an evolution and several distinct eras of care can be identified, each built on outcomes data from orthopaedics and general surgery damage control strategies, and recognition of the important influence of the inflammatory cascade on multisystem outcomes. In current damage control orthopaedic strategy, the first surgical priority is of course to save the patient's life, then limb when feasible. Initial procedures should be limited to two hours or less. Open fractures should be irrigated and debrided. Hemorrhage control is paramount for patients in extremis; stabilization of major fractures is secondary. For unstable patients, major fractures should be stabilized with external fixators. For borderline patients, definitive fixation can be undertaken within the 2 hour time limit. Stable patients can undergo primary definitive fixation.

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Authors and Affiliations

  1. R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA

    Julie M. Keller & Andrew N. Pollak

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  1. Julie M. Keller
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Correspondence to Julie M. Keller .

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Editors and Affiliations

  1. Ziv Medical Center, Str. Rambam 1, Zefat, 13100, Israel

    Alexander Lerner

  2. Faculty of Medicine, Deptartment of Orthopaedic Surgery, Rambam Medical Center, Haaliyah Street 8, Haifa, 31096, Israel

    Michael Soudry

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Keller, J.M., Pollak, A.N. (2011). Damage Control Orthopaedics. In: Lerner, A., Soudry, M. (eds) Armed Conflict Injuries to the Extremities. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-16155-1_3

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  • DOI: https://doi.org/10.1007/978-3-642-16155-1_3

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